Beta blockers with calcium channel blockers

The combination of a beta adrenergic blocker with a calcium channel blocker is used when monotherapy is not fully effective at controlling symptoms.

Beta adrenergic blocking agents prevent stimulation of the beta adrenergic receptors at the nerve endings of the sympathetic nervous system and therefore decrease the activity of the heart. They block sympathetic stimulation of the heart and reduce systolic pressure, heart rate, cardiac contractility and output, so decrease myocardial oxygen demand and increase exercise tolerance. Calcium channel blockers block voltage gated calcium channels and inhibits the influx of calcium ions into cardiac and smooth muscle cells. The decrease in intracellular calcium reduces the strength of heart muscle contraction, reduces conduction of impulses in the heart, and causes vasodilatation. Decrease in intracellular calcium in the heart decreases cardiac contractility. Decreased calcium in the vascular smooth muscle reduces its contraction and therefore causes vasodilatation. Decrease in cardiac contractility decreases cardiac output and vasodilatation decreases total peripheral resistance, both of which cause a drop in blood pressure.

Combining a beta adrenergic blocker with a calcium channel blocker can improve efficacy compared to using monotherapy, although individual responses vary. The selection of type beta adrenergic blocker and calcium channel blocker is a significant factor in getting a positive response.